GAO: CMS Needs to Improve Cost, Quality Info for Consumers

Healthcare transparency tools operated by the Centers for Medicare and Medicaid Services are limited in terms of providing relevant and understandable cost and quality information for consumers, according to the Government Accountability Office.

These transparency tools—websites with health cost or quality information comparing different providers of healthcare services—are meant to improve the quality and affordability of healthcare. However, while CMS operates five transparency tools—Nursing Home Compare, Dialysis Facility Compare, Home Health Compare, Hospital Compare and Physician Compare—GAO found that the tools lack relevant information on cost and provide limited information on key differences in quality of care, which hinders the ability of consumers to make meaningful distinctions among providers based on their performance.  

“Because none of the tools contain information on patients' out-of-pocket costs, they do not allow consumers to combine cost and quality information to assess the value of healthcare services or anticipate the cost of such services in advance,” auditors reveal. In addition, GAO reports “substantial limitations in how the CMS tools present information, such as, in general, not using clear language and symbols, not summarizing and organizing information to highlight patterns, and not enabling consumers to customize how information is presented.”

Though CMS has taken some steps to expand access to cost and quality information for consumers, the agency has not established procedures or metrics to ensure the information it collects and reports meets consumer needs, according to GAO. In particular, auditors argue that the CMS process for developing and selecting cost and quality measures for its tools has been “heavily influenced by the concerns of providers rather than consumers.”

GAO recommended that CMS take steps to improve the information in its transparency tools and develop procedures and metrics to ensure that tools address consumers' needs. In response, the Department of Health and Human Services concurred with the recommendations and stated its intention to ensure that the transparency tools fully address consumer priorities. For example, HHS stated that it is committed, to the extent feasible, to providing estimated out-of-pocket costs to Medicare beneficiaries for common procedures that can be planned in advance. However, HHS noted that there are challenges to collecting all of the relevant cost information.

HHS also agreed to organize the cost and quality information provided in its Compare websites to facilitate consumer identification of the highest performing providers, such as by listing providers in order based on ratings of the quality of their performance. In addition, the department will enable consumers to customize the information presented to them on the Compare websites. And, HHS will develop specific procedures and performance metrics to ensure that its transparency tools adequately address the needs of consumers.